Publication date Sep 06, 2007
Many of us forget things as we get older. But if someone has Alzheimer’s or another type of dementia, this forgetfulness gets very bad. The symptoms get worse over time and it can be a great strain to care for someone with Alzheimer's.
Alzheimer’s disease is the most common type of dementia. Dementia is a term doctors use to describe what happens when someone’s brain stops working properly. Other common types are vascular dementia, which can happen to someone who's had a stroke, and Lewy body dementia.
Dementia is an illness. It's not a normal part of getting older. But dementia is more common in older people. It's possible for younger people to get Alzheimer's, but it’s rare.
The first sign of Alzheimer's disease is usually mild forgetfulness. At first, someone may have trouble remembering small things, like what they did yesterday. They may get lost or confused easily. Eventually, they may forget how to do important, everyday things, like cooking meals, getting dressed or using the toilet. They may not recognise even close family members. This can make it very hard for someone with Alzheimer's to look after themselves.
The symptoms usually come on gradually. It's often a friend or relative who notices the illness and suggests seeing a doctor. But for someone who's had a stroke, dementia can start suddenly.
The problems someone gets because of dementia can make it seem as if that person's personality has changed. They may become agitated or moody, pace about, or wander off. They may have trouble talking or understanding you. Some people imagine that things are happening to them (they have delusions) or see things that aren't really there (they have hallucinations). This can be upsetting. For example, someone may think that people are trying to hurt them or steal their things. Some people become aggressive.
It can be very difficult seeing someone you love change because of their illness. There will probably be times when it seems as if they're being deliberately difficult. But it’s important to remember that your relative or loved one can't help their behaviour. Often, someone with Alzheimer's won't realise that anything's wrong.
It may help to try to relate to what the person is feeling, rather than what they're saying. For example, if someone thinks their things are being stolen, they may be anxious about forgetting where they've put things. You could try putting labels on things, or making sure things are always put away in the same place.
If your loved one or relative has delusions or hallucinations, there's no point in trying to persuade them that the things they think are happening aren't real. It's better to gently distract or reassure them than argue. Simple things, like going for a drive or listening to music may help.
You also need to make sure you have some time to yourself. It may help to have a few days away every so often, if possible. You may feel guilty about doing this. But looking after your own needs will help you take care of your loved one better.
Unfortunately, there's no cure for Alzheimer's disease and most other kinds of dementia. There are medicines that can help a little with forgetfulness and confusion. But they don't work for everyone.
Drug treatments are only a part of the care that people with dementia and their families need. Someone with dementia will eventually need lots of help looking after themselves.
Several drugs are designed to help people with Alzheimer's disease. These are donepezil (brand name Aricept), galantamine (Reminyl), rivastigmine (Exelon) and memantine (Ebixa). Studies show that people remember things a bit better and are a little less confused after taking these drugs. And some research has found that these drugs may help people with dementia look after themselves for longer.
However, these drugs don't help everyone, and you're unlikely to see a big improvement. We don't know how long they keep working for, although some research on donepezil has found it may still help after two years.
In the UK, there are guidelines for NHS doctors about when they should prescribe these medicines. The guidelines say that donepezil, galantamine and rivastigmine should only be prescribed for people with moderate Alzheimer's disease. They shouldn't be used for people with mild or severe Alzheimer's disease. Guidelines on memantine say it can be used for moderate or severe Alzheimer's disease, but only as part of a clinical trial.
All these drugs have side effects. Some of the most common are feeling sick, getting diarrhoea or not feeling like eating. You or your loved one don't have to put up with side effects. A different drug or a change of dose may help, so talk to your doctor. For example, donepezil and galantamine seem to cause fewer side effects than rivastigmine.
There's research to show that a herbal remedy called ginkgo biloba may help people with Alzheimer's disease and other kinds of dementia. In studies, people who took it could think more clearly and got on with other people better. But the improvement is likely to be small. You can buy Ginkgo biloba from health food shops and chemists, and on the Internet. Bear in mind that herbal products aren't tested in the same way as medicines. You can't always be sure how pure a product is.
Ginkgo biloba doesn't have many side effects. However, people who take Ginkgo should tell their doctor. That's because it can be harmful if taken with some other drugs, especially drugs to prevent blood clots (such as aspirin or warfarin).
Doing things they enjoy and being as independent as possible can help someone with Alzheimer's continue to get the most out of life. There are several ways that therapists try to do this. If you’re close to someone with Alzheimer’s, you may wish to try some of these ideas yourself.
Some therapists use things like word or number games, practising with money, or looking at pictures of famous faces. This is called cognitive stimulation. To help someone with dementia feel involved with life, they may be encouraged to talk about people in family photographs, play games or do jigsaws. A large calendar or a blackboard can be used to remind people about what's happening that day. This kind of approach is called reality orientation. Music therapy can also be used to try to help someone with Alzheimer's feel happier or more relaxed. It can involve listening to a CD, going to a concert, or even dancing or playing instruments. Some research suggests music can help people feel less restless and upset.
Occupational therapy aims to help people stay independent. An occupational therapist can give advice on how to make day-to-day things easier. They can also suggest how to adapt someone's home to help them cope.
A treatment called reminiscence therapy aims to help people exercise their memory. People with Alzheimer's can often remember things that happened a long time ago better than things that happened recently. A therapist might ask someone questions about their childhood, or suggest they handle objects from their past. There’s not much research, but it may help.
Even simple things, like aromatherapy, playing with a pet or listening to music, may help someone with Alzheimer's feel happier about life.
Some people with Alzheimer's disease become very distressed at times. They may get upset and anxious, or become convinced that unpleasant things are happening around them. Some people become angry or even aggressive. If these things happen to your relative or loved one, there are several treatments that their doctor may suggest.
Before considering medicines, it may help to think whether any changes to someone's care could help them be less distressed. For example, someone might like more privacy, or want to be kept busy more of the time. Poor eyesight can make hallucinations more likely, so an eye test might be a good idea.
Drug treatments for agitation can have side effects, and older people tend to be particularly vulnerable to the side effects of drugs. Some of the drugs we talk about here aren't suitable for some types of dementia. Drowsiness is a common side effect of drugs for people who are agitated, even to the point where someone passes out. Make sure you talk to your doctor about side effects. A different drug or a change of dose may help to prevent them. If a doctor prescribes drugs for someone who's agitated, the treatment should be reviewed regularly. It should be stopped if it's no longer needed or doesn't help any more.
Drugs like haloperidol (brand name Haldol), olanzapine (Zyprexa) and risperidone (Risperdal) are designed to help people who get delusions. That's when someone thinks that something they've imagined is really happening. And an epilepsy drug called carbamazepine (Tegretol) is sometimes used to treat people who are agitated. There's research to show that these drugs can help, but there's also a risk of severe side effects.
In the UK, doctors have been told that olanzapine and risperidone can increase someone's risk of dying of a stroke. So these two drugs aren't recommended to treat Alzheimer's disease or other types of dementia.
It's hard to know how quickly someone's symptoms will get worse. Everyone's different. Some people stay the same for a long time. Others have some good days and some bad days. Eventually, most people with Alzheimer's need help with everyday things, like getting washed and dressed.
People with mild Alzheimer's may wish to plan for the future and discuss their treatment with relatives. Some people write an advance directive, describing the care they'd prefer. People with dementia can lose the ability to keep track of money. So it's important to decide who should help with decisions about money and health care.
If you're on your own and caring for someone with Alzheimer's or another kind of dementia, there will be a time when it becomes hard to cope. You may be able to get help at home, or think about full-time care in a nursing home. Remember that there may be a charge for these services. Decisions about caring for someone you love can be difficult and upsetting. It's probably wise to think about these things sooner rather than later. This gives you plenty of time to look at the options and make the right choice.
You also need to make sure your own health and wellbeing don't suffer. It's important to remember that your loved one will probably need full-time care, possibly in a nursing home, at some point. It may help to prepare for this in good time, even if you think you'll be able to cope for a while yet.
It can be very difficult to care for someone with the later stages of Alzheimer's or another type of dementia. Some family carers go on coping alone for a long time, and the strain can be enormous. Make sure you get all the help you can, for example from your family, the NHS and social services. There are also local carers' groups that may be able to give you support. For advice, you can contact the Alzheimer's Society (http://www.alzheimers.org.uk), Alzheimer Scotland (http://www.alzscot.org) and Carers UK (http://www.carersuk.org). Your doctor will be also able to suggest where you can go for help.
This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.
© BMJ Publishing Group Limited ("BMJ Group") 2007. All rights reserved
This information does not replace medical advice.
If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.